title: The outcome of twin-twin transfusion syndrome complicated with placental insufficiency.
abstract: OBJECTIVE
  The aim was to evaluate the incidence and perinatal outcomes of TTTS complicated with placental insufficiency (PI/TTTS).
  
  
  METHODS
  This was a retrospective study of all TTTS with PI. PI is defined as estimated fetal weight < 10% with elevated head circumference/abdominal circumference ratio and weight discordance > 20%.
  
  
  RESULTS
  Fifty-two out of 270 (19%) pregnancies met criteria. Forty-nine (94.2%) donor twins were diagnosed with PI/TTTS. Fifteen were treated with amnioreduction, 26 with selective fetoscopic laser photocoagulation, 4 with donor intrafetal radiofrequency ablation (RFA), and 7 had expectant management. There was a high incidence of abnormal Dopplers and abnormal placental cord insertion in the donor twin (58% marginal, 35% membranous) with a mean estimated fetoscopic donor placental share of 26.1 +/- 14.3%. There was a significant decrease in the overall donor survival rate of 61% (4 RFA selected donors were excluded) as compared to overall recipient survival rate of 85%, respectively (P = .009). There was no significant difference in donor or recipient survival rate among the treatment groups (P = .058).
  
  
  CONCLUSIONS
  Placental insufficiency impacts the survival of the affected twins in the setting of TTTS. Studies are needed for appropriate treatment in TTTS with placental insufficiency.
authors.affiliation: Fetal Care Center of Cincinnati, Cincinnati Children's Hospital, University Hospital, Cincinnati, OH 45229-3039, USA.
authors.forename: Mounira
authors.initials: M
authors.lastname: Habli
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Livingston
authors.forename: Jeffery
authors.initials: J
authors.lastname: Harmon
authors.forename: Foong Yen
authors.initials: FY
authors.lastname: Lim
authors.forename: William
authors.initials: W
authors.lastname: Plozin
authors.forename: Timothy
authors.initials: T
authors.lastname: Crombleholme
mesh_terms: D000328:Adult; D017115:Catheter Ablation; D005260:Female; D005317:Fetal Growth Retardation / Q000453:epidemiology; D005330:Fetofetal Transfusion / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality* / Q000628:therapy; D005332:Fetoscopy; D006801:Humans; D015994:Incidence; D017075:Laser Coagulation; D010927:Placental Insufficiency / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D012189:Retrospective Studies; D018617:Ultrasonography, Doppler, Pulsed; D016216:Ultrasonography, Prenatal; D016276:Ventricular Function